A SURVEY TO DETERMINE THE OPERATIONAL READINESS TRAINING OF THE ARMY CERTIFIED REGISTERED NURSE ANESTHETIST PATRICIA A. KIEBLER, LT, AN APPROVED: _____________________________________ __________ W. Patrick Monaghan, CLS, SBB, Ph.D., Approval Date Committee Chair _____________________________________ ___________ Robert Halliburton, LTC, CRNA, MHS, AN, Approval Date USA, Member ______________________________________ ____________ Kenneth P. Miller, Ph.D., RN, FAAN, Member Approval Date _____________________________________ ____________ F. G. Abdellah, Ed., ScD., RN, FAAN, Dean Approval Date i
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A SURVEY TO DETERMINE THE OPERATIONAL READINESS TRAINING OFTHE ARMY CERTIFIED REGISTERED NURSE ANESTHETIST
PATRICIA A. KIEBLER, LT, AN
APPROVED:
_____________________________________ __________W. Patrick Monaghan, CLS, SBB, Ph.D., Approval DateCommittee Chair
_____________________________________ ___________Robert Halliburton, LTC, CRNA, MHS, AN, Approval DateUSA, Member
______________________________________ ____________Kenneth P. Miller, Ph.D., RN, FAAN, Member Approval Date
_____________________________________ ____________F. G. Abdellah, Ed., ScD., RN, FAAN, Dean Approval Date
i
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1. REPORT DATE OCT 1999
2. REPORT TYPE N/A
3. DATES COVERED -
4. TITLE AND SUBTITLE A SURVEY TO DETERMINE THE OPERATIONAL READINESSTRAINING OF THE CERTIFIED REGISTERED NURSE ANESTHETIST
5a. CONTRACT NUMBER
5b. GRANT NUMBER
5c. PROGRAM ELEMENT NUMBER
6. AUTHOR(S) Patricia A. Kiebler, RN, BSN
5d. PROJECT NUMBER
5e. TASK NUMBER
5f. WORK UNIT NUMBER
7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Uniformed Services University of the Health Sciences
8. PERFORMING ORGANIZATIONREPORT NUMBER
9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S)
11. SPONSOR/MONITOR’S REPORT NUMBER(S)
12. DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release, distribution unlimited
13. SUPPLEMENTARY NOTES
14. ABSTRACT The Army certified registered nurse anesthetist (CRNA) is an integral part of the health care team andoffers a valuable service to the medical care of soldiers and their families. Delivering anesthesia on thebattlefield will be vastly different from that of the technologically advanced military treatment facilities.The purpose of this study was to survey the type and amount of trauma education and experience receivedby Army CRNAs. Results of this analysis revealed a mean of 6.48± 4.6 years of military anesthesiaexperience. Annual anesthetics administered per Army medical facility ranged from 0-50,000. Traumaanesthesia is not included in 40% of current practice. Of particular interest, 71% percent of therespondents indicate that they did not have a trauma rotation in their clinical program. Fifty-three percentof respondents have been deployed. According to the questionnaire results, most respondents felt that vitaltraining could be achieved through civilian trauma experience, attending the advanced trauma life supportcourse, and participating in more deployment exercises.
the type of equipment utilized during their deployment.
Fifteen (59%) used the Model 885 field anesthesia machine.
The draw-over vaporizer was used by 30% (n=8) and other
equipment was used by 22%. Other equipment included a
Russian made field machine (n=1), the Ohio side-arm
vernitrol (n=1), and British systems (n=1). Three
respondents did not indicate what other equipment they
used. Three respondents indicated that they were in a fixed
facility and utilized Ohmeda machines.
Army Anesthesia 35
Training and Trauma Experience
The data showed that almost 15% (20/135) of the
respondents practiced trauma anesthesia outside the
military. Fifty-five percent of those who practiced trauma
(11/20) practiced at a Level 1 facility, while 35% (7/20)
practiced at a Level 2 facility. It was not indicated where
the two other respondents practiced trauma anesthesia.
Only 29% (39/135) of the respondents had a trauma
clinical site rotation, while 71 (96/135) did not. Of the
39 that did, 66% (26/39) rotated through a Level 1 center,
while 34% (13/39) rotated through a Level 2 center. Fifty-
nine percent of the respondents receive trauma patients in
their current anesthesia practice.
One question had the respondent rank order a variety
of classes/experiences as to the value in preparation for
trauma anesthesia. The scale was from 1-6, with 1 being no
value and 6 very valuable, and a NA for not applicable.
The data are shown in Table 1 below.
As is shown in Table 1, civilian experience and the
ATLS course were the most valuable in preparing the Army
CRNA for trauma anesthesia with a mean of 5.18 and 4.86 on
a scale of 1-6 respectively. Of least value is the United
States Air Force Combat Medicine Course with a mean of
Army Anesthesia 36
3.75. It must be noted, however that this course has only
been attended by four respondents.
Table 1.
Rank Order of Course/Experience
COURSE/EXP. N MEAN STD. DEV.
CIVILIAN EXP. 45 5.18 0.98
ATLS 84 4.86 1.03
DEPLOYMENT 70 4.66 1.50
HUMANITARIANMISSIONS
37 4.49 1.50
CONFERENCES 69 4.41 1.03
US ARMY C4 86 4.23 1.35
FIELDTRAINING
108 4.06 1.35
USAF COMBATMEDICINE
4 3.75 1.26
In conclusion, these data display current Army CRNA
demographics and professional experience. These results may
be useful in preparing future CRNAs for battlefield
anesthesia.
Army Anesthesia 37
CHAPTER V: SUMMARY, CONCLUSIONS, RECOMMENDATIONS
This chapter focuses on the discussion and
implications of the results. It begins with a summary of
the study followed by a discussion of the findings and
possible explanations. Finally, suggestions for further
research will be discussed.
Summary
It cannot be disputed that CRNAs need certain training
and experience to perform effectively in the battlefield
environment. Bellamy (1995) alludes to the different type
of casualty, while Donchin et al. (1990) elaborate on the
different environment. Tsuolos (1992) believes medical
people are not well trained for their wartime role This
entails the need for specific training related to trauma
anesthesia.
According to Roy s Theory of Adaptation (1991), the
CRNA constantly needs to adapt to the battlefield
environment, which is itself constantly changing. This, in
and of itself, is reason enough for specific training.
McAuliffe s Conceptual Framework for Nurse Anesthesia
Education (1993) focuses on conditional knowledge, when and
where to apply knowledge. Essentially, the CRNA needs to be
faced with various trauma cases in order to gain this
conditional knowledge. My study was performed in order to
Army Anesthesia 38
determine the current level of trauma training and
experience of the CRNA, essentially evaluating the
conditional knowledge.
A descriptive survey design was used to evaluate the
amount of trauma training and experience received by the
Army CRNA. Validity was confirmed through the use of two
Army CRNAs with anesthesia experience. The questionnaire
was mailed with an introductory letter and self-addressed,
stamped return envelope to 225 active duty Army CRNAs. This
list was received from the AANA. The response rate was 61%,
after excluding three surveys. Anonymity of the respondents
was ensured by lack of any identification associated with
any response.
Responses to the research questions were analyzed
using SPSS (1998). Frequencies and percentages were
reported along with the standard deviation. Figures and
graphs were designed to display the results.
The major study findings are as follows. The mean
number of years in military anesthesia practice is 6.48–4.6
years. Sixty percent of the respondents currently practice
trauma anesthesia. Including these trauma cases, CRNAs are
stationed at facilities that perform up to 50,000 cases per
year. Fifty-three percent of the CRNAs have been deployed.
Shortfalls included primarily a lack of training on the
Army Anesthesia 39
anesthesia equipment and lack of trauma experience. Of
interest is the value of particular courses and experiences
as indicated by the CRNA. Civilian experience and the ATLS
course were ranked as the most valuable.
Implications of the Findings
The data collected indicates a need for more trauma
education and experience by the Army CRNA. This is
identified by the responses indicating a lack of trauma
experience and a lack of training on the field equipment.
Forty percent of the CRNAs currently do not practice trauma
anesthesia. With the current status of global unrest, it is
very likely that the CRNA may be placed in an unfamiliar
trauma environment. This is not fair to our soldiers who
may require such service.
It is obvious that CRNAs as a whole would benefit from
more frequent training and operation of the field
equipment. This is something that requires performance on a
regular basis to maintain proficiency.
Suggestions for Further Research
This study lends itself very well to further research.
This survey could be sent to members of the other military
services to compare operational readiness. The survey
could be repeated to determine if there have been any
changes in the training and experience of the Army CRNA.
Army Anesthesia 40
The survey could also be modified to be used in the
civilian setting for trauma anesthesia.
Army Anesthesia 41
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Army Anesthesia 48
APPENDICES
Appendix A
Survey Questionnaire
Operational Training and Experience in Trauma Questionnaire
The purpose of this study is to identify experiences of Active Duty Certified Registered NurseAnesthetist in trauma anesthesia and to measure the value of their experience in preparation fordeployment. Please answer all questions as completely as possible.1. Branch of Service: Army(1) _______ Navy(2)________ Air Force(3)_______2. Date of CRNA certification: _____/_______ month year3. Years in military anesthesia practice: ________4. Does your military practice include trauma anesthesia? Yes(1)_________ No(2)_________
5. How many anesthetics per year are administered at your facility? _________6. Have you ever been deployed as an anesthesia provider? Yes (1)_______ No (2)
7. If you have been deployed as an anesthesia provider, please indicate where:A. Viet Nam (1)________________ D. Panama (4)____________
B. Grenada (2)_________________ E. Desert Shield/Storm (5)____________
C. Bosnia (3)___________________ F. Somalia (6)____________
G. Other (7)_____________________
8. During your deployment, which field anesthesia equipment did you use? A. Model 885 Field Anesthesia Machine (1)
B. Draw over anesthesia vaporizer (2)
C. Other (3)______________________________________
9. Were you adequately trained on the above equipment prior to deployment? Y(1) ________ N(2)
10. Please indicate the shortfalls in your training:_________________________________________________________________________________________________________________________________
11. Have you participated in any humanitarian missions, providing anesthesia? Y(1)_______N(2)
If yes, where and when?_____________________________________________________12. During any humanitarian missions, which field anesthesia equipment did you use? A. Model 885 Field anesthesia machine (1)_________
B. Draw over anesthesia vaporizer (2)_________
C. Other (3)___________________________________________________
13. Do you practice trauma anesthesia outside the military? Yes(1)________ No(2)__________
A. If yes, do you practice at a Level I trauma center? Yes(1)________ No(2)__________ Hours per month_________ B. or, a Level II trauma center? Yes(1)________ No(2)__________
Hours per month_________14. Did your Nurse Anesthesia program include a clinical site rotation in trauma anesthesia?
Yes(1)__________ No(2)___________
A. If yes, was this at a Level I trauma center? Yes(1)____________ No(2)__________
B. or at a Level II trauma center? Yes(1)____________ No(2)__________
15. Please rank order the following experiences or classes that you have participated in as to their value inpreparing you to provide trauma anesthesia during deployment. Please circle the corresponding numberwith 1 being little or no value, 6 being extremely valuable. If you have not participated in a class orprevious deployment, please circle NA. No value_________________________Very valuableA. Advanced trauma life support: 1 2 3 4 5 6 NAB. USAF Combat Medicine Course: 1 2 3 4 5 6 NAC. USA Combat Care Casualty Course (C4): 1 2 3 4 5 6 NAD. Field training exercise/Medical Red Flag: 1 2 3 4 5 6 NAE. Civilian trauma care experience: 1 2 3 4 5 6 NAF. Trauma anesthesia conferences: 1 2 3 4 5 6 NAG. Previous deployment experience: 1 2 3 4 5 6 NAH. Humanitarian mission: 1 2 3 4 5 6 NA
Appendix B
Cover Letter
20 April 1998
Dear ________,
Attached is a copy of a survey questionnaire and letter I have developed for my thesis entitled
Operational Readiness of the Army CRNA. I request that you please evaluate the survey to determine
content validity due to you vast experience in the field of anesthesia. Your comments and suggestions will
important in determining the success of this survey.
Please direct any questions regarding this evaluation to Lieutenant Patricia A. Kiebler. I may be
reached at (410) 663-9860. My mailing address is 2804 Willoughby Road, Parkville, Maryland 21234.
Thank you in advance for your time and effort regarding this evaluation. Your contributions are
greatly appreciated.
Patricia A. Kiebler, LT, USAUniformed Services University of the Health SciencesGraduate School of Nursing
Appendix C
Content Validity Tool
Validity Test
Please rate the relevance of each question pertaining to
the operational readiness of the Army CRNA. Use the
following scale.
1-not relevant
2-somewhat relevant
3-relevant
4-very relevant
Question Number Degree of Relevance
1 1 2 3 4
2 1 2 3 4
3 1 2 3 4
4 1 2 3 4
5 1 2 3 4
6 1 2 3 4
7 1 2 3 4
a 1 2 3 4
b 1 2 3 4
c 1 2 3 4
d 1 2 3 4
e 1 2 3 4
f 1 2 3 4
g 1 2 3 4
8 1 2 3 4
a 1 2 3 4
b 1 2 3 4
c 1 2 3 4
9 1 2 3 4
10 1 2 3 4
11 1 2 3 4
12 1 2 3 4
a 1 2 3 4
b 1 2 3 4
c 1 2 3 4
13 1 2 3 4
a 1 2 3 4
b 1 2 3 4
14 1 2 3 4
a 1 2 3 4
b 1 2 3 4
15
a 1 2 3 4
b 1 2 3 4
c 1 2 3 4
d 1 2 3 4
e 1 2 3 4
f 1 2 3 4
g 1 2 3 4
h 1 2 3 4
Please provide any comments or suggestions below.
Appendix D
CRNA Cover Letter
20 April 1998
Dear ________,
Attached is a copy of a survey questionnaire andletter I have developed for my thesis entitled OperationalReadiness of the Army CRNA. I request that you pleaseevaluate the survey to determine content validity due toyou vast experience in the field of anesthesia. Yourcomments and suggestions will important in determining thesuccess of this survey.
Please direct any questions regarding this evaluationto Lieutenant Patricia A. Kiebler. I may be reached at(410) 663-9860. My mailing address is 2804 Willoughby Road,Parkville, Maryland 21234.
Thank you in advance for your time and effortregarding this evaluation. Your contributions are greatlyappreciated.
Patricia A. Kiebler, LT, USAUniformed Services Universityof the Health SciencesGraduate School of Nursing